Appendectomy – Clinical and Economic Outcomes

Clinical + Economic Outcomes – Appendectomy

Compared to the traditional “open” procedure, the minimally invasive approach for appendectomy surgery may offer:

  • Shorter hospital stay – reduced length of stay for an average of 0.1 to 6 days.*,20
  • Shorter recovery time – time before returning to normal activities reduced by an average 0.6 to 13 days.†,20
  • Quicker return to work – time before returning to work reduced by an average of 0.3 to 9 days.‡,20
  • Less pain and scarring.
  • Fewer narcotics – 14.0mg compared to 34mg.18

There are risks with any surgery, such as adverse reactions to medications, problems with anesthesia, problems breathing, bleeding, blood clots, inadvertent injury to nearby organs and blood vessels, even death. The procedure for removal of the appendix (appendectomy) has its own risks, including slowing down of the intestinal tract (paralytic ileus), wound infection with possible abscess formation, post-operative bowel leak, and pneumonia. Patients should consult their physicians to determine if this procedure is appropriate for their condition.

Economic data

When compared to an “open” procedure, laparoscopic appendectomy is $700 less expensive48 and is associated with a 50% less postoperative infection rate.49 Keep in mind, the average incremental cost associated with appendectomy when a patient develops a nosocomial infection is $6,108.49 When controlling for this expenditure, the average incremental cost savings from a laparoscopic versus an “open” appendectomy was $1,032.49

A shift to outpatient appendectomy surgery

In a traditional “open” appendectomy surgery, a 2 to 3-inch abdominal incision is made, cutting through the muscles in the lower right quadrant. The same procedure can be performed minimally invasively, where several small ¾-inch incisions allow a laparoscope (a miniature camera) to guide specialized surgical instruments via video monitor.

Along with the trend toward more minimally invasive appendectomies driven by patient demand, there has also been a shift to outpatient status for the procedure. Hospital stays are undesirable to patients and expensive for payors. while in 2014, 24% of all appendectomies were outpatient procedures, the estimated shift to reach 44% was realized in 2013.460

While this shift to outpatient status would mean more hospital beds will be free for acute care patients, it is worth noting that it is being resisted by some surgeons who are not comfortable with the outpatient setting for appendectomy surgery.460

Faster recovery chartOutpatient shift chart

Site References

  • * In a review of 37 studies, 26 studies found an average reduced length of stay of 0.1 to 6 days. Six studies showed no difference in length of stay between open and minimally invasive approaches, while 5 studies found that minimally invasive approaches were associated with an increased length of stay.
  • In a review of 14 studies, 11 studies found an average quicker return to normal activities of 0.6 to 13 days. One study showed no difference in return to normal activities between open and minimally invasive approaches, while 2 studies found that minimally invasive approaches were associated with a longer return to normal activities.
  • In a review of 10 articles, 8 studies found an average quicker return to work of 0.3 to 9 days. Two studies found no difference between minimally invasive and open approaches with respect to duration of time before returning to work.
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